1013346337 NPI number — MR. ANTONIO RUIZ MA. MFT INTERN

Table of content: MR. ANTONIO RUIZ MA. MFT INTERN (NPI 1013346337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013346337 NPI number — MR. ANTONIO RUIZ MA. MFT INTERN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUIZ
Provider First Name:
ANTONIO
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA. MFT INTERN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUIZ
Provider Other First Name:
TONY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA. MFT INTERN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013346337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10110 LEUCADIA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92503-1030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-217-5233
Provider Business Mailing Address Fax Number:
951-530-1601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10110 LEUCADIA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92503-1030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-217-5233
Provider Business Practice Location Address Fax Number:
951-530-1601
Provider Enumeration Date:
11/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  #73702 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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